Talwani Rohit, Falusi Oluwatoyin M, Mendes de Leon Carlos F, Nerad Judith L, Rich Stuart, Proia Laurie A, Sha Beverly E, Smith Kimberly Y, Kessler Harold A
Section of Infectious Diseases, Department of Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA.
J Acquir Immune Defic Syndr. 2002 Jun 1;30(2):191-5. doi: 10.1097/00042560-200206010-00008.
Hyperlipidemia has been seen in patients receiving protease inhibitor-based antiretroviral therapy, prompting concern that such patients are at risk for accelerated coronary artery disease (CAD). To assess the risk of CAD in antiretroviral-treated HIV-infected men, we quantified coronary artery calcium (CAC), a sensitive and established marker of subclinical CAD, using electron beam computed tomography (EBCT) of coronary vessels. Sixty HIV-infected men who met the following criteria (cases) were enrolled in the study: age of 40 years or older; naive to antiretroviral therapy or use of a stable antiretroviral regimen for >or=6 months (mean duration, 25.9 months; 41 patients were receiving protease inhibitor therapy); and no known CAD or no use of lipid-lowering agents. EBCT-derived CAC scores, serum lipid levels, history of antiretroviral therapy, and risk factors for CAD were obtained. Each case was compared with three age-, sex-, and race-matched HIV-negative controls randomly selected from a database including >9000 patients who had undergone EBCT. We determined differences in the proportion of cases and controls with CAC scores of >0 (detectable calcium) and clinically significant CAC for age range. There were no statistically significant differences between the number of cases and controls with detectable CAC (33% and 39%, respectively) and clinically significant CAC (18% and 17%, respectively). This study suggests that the rate of coronary atherosclerosis among HIV-infected patients who receive short-term antiretroviral therapy with or without protease inhibitors is not higher than that among age-, sex-, and race-matched HIV-negative controls. These results need to be confirmed in larger long-term studies, with controls well matched for coronary risk factors.
接受基于蛋白酶抑制剂的抗逆转录病毒治疗的患者中出现了高脂血症，这引发了人们对这类患者有加速冠状动脉疾病（CAD）风险的担忧。为了评估接受抗逆转录病毒治疗的HIV感染男性患CAD的风险，我们使用冠状动脉血管的电子束计算机断层扫描（EBCT）对冠状动脉钙化（CAC）进行了量化，CAC是亚临床CAD的一种敏感且已确立的标志物。符合以下标准的60名HIV感染男性（病例）被纳入研究：年龄在40岁及以上；未接受过抗逆转录病毒治疗或使用稳定的抗逆转录病毒方案≥6个月（平均持续时间为25.9个月；41名患者接受蛋白酶抑制剂治疗）；且无已知CAD或未使用降脂药物。获取了EBCT得出的CAC评分、血脂水平、抗逆转录病毒治疗史以及CAD的危险因素。将每个病例与从一个包含9000多名接受过EBCT的患者的数据库中随机选取的三名年龄、性别和种族匹配的HIV阴性对照进行比较。我们确定了病例和对照中CAC评分＞0（可检测到钙）以及临床上显著的CAC在各年龄范围的比例差异。有可检测到的CAC（分别为33%和39%）和临床上显著的CAC（分别为18%和17%）的病例和对照数量之间没有统计学上的显著差异。这项研究表明，接受短期抗逆转录病毒治疗（无论是否使用蛋白酶抑制剂）的HIV感染患者中冠状动脉粥样硬化的发生率并不高于年龄、性别和种族匹配的HIV阴性对照。这些结果需要在更大规模的长期研究中得到证实，且对照在冠状动脉危险因素方面要匹配良好。
